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Uncertain Future: Affordable Care Act and Medicaid in the States

Health policies and programs in the states face an uncertain future with the election of Donald J. Trump. During his campaign he vowed to repeal the Affordable Care Act.

Currently 73 million Americans are enrolled in the Medicaid program, a federal-state partnership program for which the federal government pays 62 percent of total expenditures. A Medicaid block grant, one proposal under discussion, might provide the states more flexibility but also might transfer more financial responsibility, especially in the long term, to the states.

Since the passage of the ACA, more Americans have health insurance. Health insurance plans for 2016 were selected by 12.7 million persons during the last open enrollment period. In twelve states, 3.1 million selected plans from health exchanges run by states. The plans are affordable because the ACA provided tax credits that reduced the average premium to $105 in 2016.

More than half the states--31--have expanded eligibility for Medicaid, to an income level of 138 percent of the federal poverty level as allowed under the ACA. Since the passage of the ACA, Medicaid enrollment has increased by 16.7 million.

The ACA provision allowing dependents up to the age of 26 to be covered under their parents' health insurance has provided health coverage to over 6 million young adults, ages 19 to 25.